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Nonsurgical rescue after basket-stone impaction by endoscopic cutting of a metallic lithotripter and laser lithotripsy.

ABSTRACT: Video 1Endoscopic rescue strategy for basket-stone impaction.

SUBMITTER: Terauchi T

PROVIDER: S-EPMC8430378 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Resolution of ampullary stone impaction with duodenoscopy-guided direct frequency-doubled double-pulse Nd:YAG laser lithotripsy after the failure of rescue lithotripsy.

Project description: Not available

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Impacted gallstone within a cholecystoduodenal fistula: endoscopic laser lithotripsy to the rescue.

Project description:Video 1A large, impacted gallstone is treated unsuccessfully with electrohydraulic lithotripsy; however, fragmentation and removal is accomplished using endoscopic laser lithotripsy.

| S-EPMC9832218 | biostudies-literature

Troubleshooting impaction of a pancreatoscopy-guided retrieval basket during pancreatic duct stone removal.

Project description:Video 1Successful removal of impacted cholangiopancreatoscopy-guided retrieval basket.

| S-EPMC10422077 | biostudies-literature

Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study.

Project description:Introduction and objectiveThermal injuries associated with Holmium laser lithotripsy of the urinary tract are an underestimated problem in stone therapy. Surgical precision relies exclusively on visual target identification when applying laser energy for stone disintegration. This study evaluates a laser system that enables target identification automatically during bladder stone lithotripsy, URS, and PCNL in a porcine animal model.MethodsHolmium laser lithotripsy was performed on two domestic pigs by an experienced endourology surgeon in vivo. Human stone fragments (4-6 mm) were inserted in both ureters, renal pelvises, and bladders. Ho:YAG laser lithotripsy was conducted as a two-arm comparison study, evaluating the target identification system against common lithotripsy. We assessed the ureters' lesions according to PULS and the other locations descriptively. Post-mortem nephroureterectomy and cystectomy specimens were examined by a pathologist.ResultsThe sufficient disintegration of stone samples was achieved in both setups. Endoscopic examination revealed numerous lesions in the urinary tract after the commercial Holmium laser system. The extent of lesions with the feedback system was semi-quantitatively and qualitatively lower. The energy applied was significantly less, with a mean reduction of more than 30% (URS 27.1%, PCNL 52.2%, bladder stone lithotripsy 17.1%). Pathology examination revealed only superficial lesions in both animals. There was no evidence of organ perforation in either study arm.ConclusionsOur study provides proof-of-concept for a laser system enabling automatic real-time target identification during lithotripsy on human urinary stones. Further studies in humans are necessary, and to objectively quantify this new system's advantages, investigations involving a large number of cases are mandatory.

| S-EPMC8332575 | biostudies-literature

Endoscopic holmium laser lithotripsy for therapy of Bouveret syndrome.

Project description:Video 1Video of holmium laser lithotripsy procedure.

| S-EPMC10020008 | biostudies-literature

Shock waves generated by toroidal bubble collapse are imperative for kidney stone dusting during Holmium:YAG laser lithotripsy.

Project description:Holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy (LL) has been the treatment of choice for kidney stone disease for more than two decades, yet the mechanisms of action are not completely clear. Besides photothermal ablation, recent evidence suggests that cavitation bubble collapse is pivotal in kidney stone dusting when the Ho:YAG laser operates at low pulse energy (Ep) and high frequency (F). In this work, we perform a comprehensive series of experiments and model-based simulations to dissect the complex physical processes in LL. Under clinically relevant dusting settings (Ep = 0.2 J, F = 20 Hz), our results suggest that majority of the irradiated laser energy (>90 %) is dissipated by heat generation in the fluid surrounding the fiber tip and the irradiated stone surface, while only about 1 % may be consumed for photothermal ablation, and less than 0.7 % is converted into the potential energy at the maximum bubble expansion. We reveal that photothermal ablation is confined locally to the laser irradiation spot, whereas cavitation erosion is most pronounced at a fiber tip-stone surface distance about 0.5 mm where multi foci ring-like damage outside the thermal ablation zone is observed. The cavitation erosion is caused by the progressively intensified collapse of jet-induced toroidal bubble near the stone surface (<100 μm), as a result of Raleigh-Taylor and Richtmyer-Meshkov instabilities. The ensuing shock wave-stone interaction and resultant leaky Rayleigh waves on the stone surface may lead to dynamic fatigue and superficial material removal under repeated bombardments of toroidal bubble collapses during dusting procedures in LL.

| S-EPMC10623368 | biostudies-literature

A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size.

Project description:Background and Objectives: This systematic review and meta-analysis was conducted to analyze the treatment outcomes of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) according to the ureteral stone size. Materials and Methods: In this systematic review, relevant articles that compared SWL and URSL for treatment of ureteral stones were identified. Articles were selected from four English databases including Ovid-Medline, Ovid-EMBASE, the Cochrane Central Register of controlled Trials (Central), and Google Scholar. A quality assessment was carried out by our researchers independently using the Scottish Intercollegiate Guidelines Network (SIGN). A total of 1325 studies were identified, but after removing duplicates, there remained 733 studies. Of these studies, 439 were excluded, 294 were screened, and 18 met the study eligibility criteria. Results: In randomized control trial (RCT) studies, URSL showed significantly higher SFR than SWL (p < 0.01, OR= 0.40, 95% CI 0.30-0.55, I² = 29%). The same results were shown in sub-group analysis according to the size of the stone (<1 cm: p < 0.01, OR = 0.40, 95% CI 0.25-0.63; >1 cm: p < 0.01, OR = 0.38, 95% CI 0.19-0.74, I² = 55%; not specified: p < 0.01, OR = 0.43, 95% CI 0.25-0.72, I² = 70%). In the non-RCT studies, the effectiveness of the URSL was significantly superior to that of SWL (p < 0.01, OR = 0.33, 95% CI 0.21-0.52, I² = 83%). Retreatment rate was significantly lower in URSL than in SWL regardless of stone size (p < 0.01, OR = 10.22, 95% CI 6.76-15.43, I² = 54%). Conclusions: Meta-analysis results show that SFR was higher than SWL in URSL and that URSL was superior to SWL in retreatment rate. However, more randomized trials are required to identify definitive conclusions.

| S-EPMC8703529 | biostudies-literature

EUS-directed transenteric ERCP with giant intrahepatic stone lithotripsy after a LAMS-in-LAMS rescue in response to a misdeployment.

Project description:Video 1LAMS-in-LAMS rescue of a misdeployment during EUS-directed transenteric ERCP. LAMS, Lumen-apposing metal stent.

| S-EPMC10927494 | biostudies-literature

Ureteral stricture formation after removal of proximal ureteral stone: retroperitoneal laparoscopic ureterolithotomy versus ureteroscopy with holmium: YAG laser lithotripsy.

Project description:ObjectiveTo compare the risk of postoperative ureteral stricture formation following retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL) in patients with proximal ureteral stones.Materials and methodsWe retrospectively reviewed the medical records of patients who underwent RPLU or URSL for proximal ureteral stones between April 2011 and May 2015. Patients were allocated into URSL group or RPLU group and the outcomes were compared.ResultsA total of 201 patients who underwent 209 procedures including 159 URSL and 50 RPLU with a median follow-up of 30 months were included. No significant difference was observed among the two groups in most baseline parameters, while the stone size was significantly larger in the RPLU group (11.37 ± 2.97 vs 14.04 ± 4.38 mm, p = 0.000). Patients in RPLU group had markedly longer operative time (p = 0.000) and longer postoperative hospital stay (p = 0.000). The initial and one-month stone-free rates were significantly higher in the RPLU group (78.6% vs 100%, p = 0.000 and 82.4% vs 100%, p = 0.001, respectively). Patients in the RPLU had a higher complication rate (18.0% vs 9.4%, p = 0.098) and lower ureteral stricture rate (2.5% vs 2.0%, p = 1.000), while the difference was not significant. Further logistic regression model identified RPLU and female sex as independent risk factors for postoperative complication (Odds Ratio[OR] = 3.57, p = 0.035 and OR = 3.57, p = 0.025, respectively); however, URSL was not an independent risk factor for the formation of postoperative ureteral stricture after adjusting confounding variables (OR = 0.90, p = 0.935).ConclusionRPLU and URSL have similar postoperative ureteral stricture formation risks. RPLU can provide significantly higher stone clearance rate, but relates with more postoperative complications.

| S-EPMC5494178 | biostudies-literature

Laser lithotripsy of difficult bile duct stones: results in 60 patients using a rhodamine 6G dye laser with optical stone tissue detection system.

Project description:INTRODUCTION: Laser lithotripsy of bile duct stones has become a widely accepted endoscopic treatment modality for giant, impacted, or very hard stones. The procedure is usually carried out under direct endoscopic control in view of the potential risk of bile duct injuries in "blind" laser application. AIMS: To investigate the use of a rhodamine 6G laser lithotriptor with an integrated optical stone tissue detection system (oSTDS). METHODS: From 1 September 1991 to 7 March 1997, 60 patients with giant or impacted common bile duct stones refractory to endoscopic papillotomy stone extraction, and mechanical lithotripsy were treated via the endoscopic retrograde route using a rhodamine 6G dye laser (595 nm, 2.5 micros, 80-150 mJ pp, Lithognost Telemit/Baasel Corp., Germany) with integrated oSTDS. In case of tissue contact oSTDS cuts off the laser pulse after 190 ns (transmission of 5-8% of the total pulse energy). 47 patients (78.3%) were subjected to x ray targeting (oSTDS) alone, five (8.3%) to choledochoscope targeting alone, and eight (13.3%) to both techniques. RESULTS: At the end of treatment 52 (87%) patients were completely stone-free. The only major complications included transient haemobilia, cholangitis, and pancreatitis in five patients. All five were successfully treated by conservative methods. CONCLUSIONS: Laser lithotripsy using the described rhodamine 6G dye laser with oSTDS seems to be safe and effective and allows "blind" fragmentation of difficult common bile duct stones under radiological control only.

| S-EPMC1727348 | biostudies-other

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